=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093460990
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUZANNE R EATON PSY.D. PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/18/2022
-----------------------------------------------------
Last Update Date | 02/18/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3712 OLD FOREST RD. SUITE 500 UNIT 1
-----------------------------------------------------
City | LYNCHBURG
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24501
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 434-609-4099
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3712 OLD FOREST RD. SUITE 500 UNIT 1
-----------------------------------------------------
City | LYNCHBURG
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 24501
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 434-609-4099
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LICENSED CLINICAL PSYCHOLOGIST
-----------------------------------------------------
Name | SUZANNE R EATON
-----------------------------------------------------
Credential | PSY.D.
-----------------------------------------------------
Telephone | 434-609-4099
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------